Philly’s Next Heroin Epidemic

THERE ARE MANY THINGS YOU MIGHT IMAGINE the nation’s drug czar saying in an interview; the blunt assessment that “we’ve kind of taken our eye off the ball” when it comes to heroin isn’t one of them.

I’m sitting in the Washington, D.C., office of Gil Kerlikowske, President Obama’s drug czar. His official title is director of the Office of National Drug Control Policy. The public thinks the drug czar directs operations against kingpins and deploys federal agents, that he can put boots on the ground in Philadelphia or open treatment centers in rural Pennsylvania. In reality, the drug czar advises the president, constructs policy, and uses his bully pulpit to inform and influence the public. He has a staff of researchers, not police.

Kerlikowske looks like an Army general­—solidly built, square jaw, short hair parted on the side. He isn’t a firebrand in the mold of William Bennett or Barry McCaffrey, but he has stirred controversy. In 2009 he told the Wall Street Journal he wanted to retire the phrase “war on drugs.” “We’re not at war with people in this country,” Kerlikowske said. He went on to emphasize the role treatment and education would play in the national drug strategy (and he deserves credit for being the first czar to deal aggressively with prescription pill abuse).

“Heroin is making a comeback in several ways,” he tells me. “One, among young people. Young people essentially say, ‘Gee, you know what? If I smoke it or I snort it, then I don’t really have to worry that much about addiction.’ And of course it isn’t long after that they could actually be injecting. And at the same time, if you have all of this attention and focus on reducing the prescription opiate painkillers … heroin is cheaper and essentially does much the same thing. The difference, of course, is that with the prescription you know exactly what you’re getting, and the dosage.”

I ask whether he wants to approach the problem any differently than the government has in the past.

“I think if we’ve learned anything, it’s that we need to spend more time and money and attention on prevention,” Kerlikowske says. “We know much more now about prevention programs that actually work, and we know that they can be relatively inexpensive.” One such prevention program is the National Youth Anti-Drug Media Campaign, which creates educational television, radio and Internet ads that Kerlikowske’s office oversees. Congress eliminated funding for it last fall.

“On heroin in particular,” Kerlikowske says, “I don’t think we’ve done as good a job, because we’ve kind of taken our eye off the ball. Because, well, heroin use has been down for a number of years.”

Down, but not down everywhere. Kerlikowske says he learned a lesson with methamphetamine, use of which was low nationally­ but spiking in less-populated areas. “Methamphetamine was a real wake-up call to this office,” he says. “We said, ‘Gee, if we look at the national numbers around drug use, methamphetamine is usually the lowest in the aggregate.’ What was kind of not recognized was that if you’re in Tacoma, Washington, or a place in Iowa that’s been ravaged by meth, and it’s a smaller suburban, rural kind of community, people don’t really care what the national numbers are. At all.”

He says it’s too soon to know whether­ pain-pill addicts will begin using heroin­ in numbers large enough to cause an epidemic—­“We’re not crying wolf”—however­ troubling the anecdotal evidence may be. Kerlikowske says he plans to fight the lack of awareness of what heroin can do, to focus attention as he did with prescription pill abuse. It’s needed. “If you talk to some people on the streets,” he says, “they’ll say, ‘Oh, heroin, wasn’t that a problem 20 years ago?’”